Neural Function Before and After Mindfulness-Based Cognitive Therapy in Anxious Adolescents at Risk for Developing Bipolar Disorder

Abstract

Objective: We sought to evaluate the neurophysiology of mindfulness-based cognitive therapy for children (MBCT-C) in youth with generalized, social, and/or separation anxiety disorder who were at risk for developing bipolar disorder.

Methods: Nine youth (mean age: 13 ± 2 years) with a generalized, social, and/or separation anxiety disorder and a parent with bipolar disorder completed functional magnetic resonance imaging (fMRI) while performing a continuous processing task with emotional and neutral distractors (CPT-END) prior to and following 12 weeks of MBCT-C.

Results: MBCT-C was associated with increases in activation of the bilateral insula, lentiform nucleus, and thalamus, as well as the left anterior cingulate while viewing emotional stimuli during the CPT-END, and decreases in anxiety were correlated with change in activation in the bilateral insula and anterior cingulate during the viewing of emotional stimuli (p < 0.05, uncorrected; p < 0.005 corrected; cluster size, 37 voxels).

Conclusions: MBCT-C treatment in anxious youth with a familial history of bipolar disorder is associated with increased activation of brain structures that subserve interoception and the processing of internal stimuli-functions that are ostensibly improved by this treatment.

Figures

FIG. 1.

Treatment-related changes in activation following mindfulness-based cognitive therapy (MBCT). Increased activation was observed in the bilateral insula and left thalamus as well as in the left anterior cingulate cortex following treatment with MBCT (p < 0.05, uncrorrected; p < 0.005 corrected; cluster size, 37 voxels). A color version of this figure is available in the online article at www.liebertpub.com/cap.

FIG. 2.

Relationship between region of interest (ROI) activation in response to emotional images and anxiety symptom severity. Correlations between baseline activation in each ROI identified in the voxelwise analysis, and changes in symptom severity are shown for the left anterior cingulate (A) and for the insula, bilaterally (B, C).